Boswellia efficacy review reveals the best-in-class for joint support

Published: 31-May-2024

The systematic review and sub-group meta analysis found AprèsFlex 5-Day Joint Support to be the most efficacious for managing joint pain, stiffness and overall movement out of the nine ingredients assessed

A scientific review of clinical studies involving Boswellia serrata (Indian frankincense) ingredients for the purpose of bolstering joint health has found that PLT Health Solutions’ AprèsFlex 5-Day Joint Support ingredient (also known as Aflapin) is most effective at helping study subjects with osteoarthritis (OA) manage pain, stiffness and overall movement.

The study, published in EXPLORE: The Journal of Science & Healing, consisted of a subgroup meta-analysis involving multiple clinical trials conducted on nine Boswellia ingredients currently on the market.


How the meta-analysis was conducted

Out of 828 studies identified, it reviewed thirteen clinical trials and nine different ingredients. Data related to the following evaluation parameters were collected: 

  • Visual analog scale (VAS) score 
  • Lequesne’s Function Index (LFI) score 
  • Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness and functionality 

Aflapin supplementation showed greater reduction in VAS, LFI, WOMAC-pain, WOMAC-stiffness, and WOMAC-function scores compared to other Boswellia serrata therapies

As part of the sub-group analysis, the authors concluded: “Aflapin supplementation showed greater reduction in VAS (MD: -16.09 vs -4.68), LFI (MD: -3.81 vs -2.01), WOMAC-pain (MD: -18.68 vs -7.07), WOMAC-stiffness (MD: -14.25 vs -3.78), and WOMAC-function (MD: -14.99 vs -8.41) scores as compared to other Boswellia serrata therapies.”1

Seth Flowerman, President & CEO of PLT Health Solutions, commented: “Consumers are becoming increasingly aware of Boswellia serrata as a safe and effective path to supporting joint comfort and better mobility. However, not all Boswellia-based ingredients are the same in composition or demonstrated efficacy. It’s essential to review the clinical science that supports these ingredients, so we can offer consumers the best products with the best results,” 

Proving Aflapin's efficacy with a six month study

In a recently completed randomised, double-blind, placebo-controlled clinical trial, 80 normal-to-overweight women and men (age 40-75) received either 100 mg/day of AprèsFlex or a matching placebo for six months.2 

Study endpoints included joint comfort (WOMAC, VAS, Lequesne Functional Index); functional capacity testing (six-minute walk, stair climb); MRI evaluation of the knee joints to assess joint space narrowing, cartilage thickness and cartilage volume.

It also included analysis of several biomarkers related to cartilage breakdown and inflammation.

Subjects experienced 25% less stiffness in the first month and a 72% reduction in stiffness at six months.

Enhancing comfort and reducing pain

Subjects taking AprèsFlex experienced steady improvement in joint comfort, with up to a 70% reduction in pain by the end of the study. 

Those same subjects experienced 25% less stiffness in the first month and a 72% reduction in stiffness at six months. AprèsFlex subjects also had a 71% improvement in physical function at six months. 
MRI assessments of femoral, patellar, lateral tibial and medial tibial cartilage thickness showed decreases in the placebo group over six months, whereas cartilage thickness and volume were maintained and even slightly improved in the AprèsFlex group at 180 days. 

Significant decreases compared to placebo in three biomarkers of cartilage degradation validated these cartilage-protective effects of AprèsFlex. 

Biomarkers of systemic and joint inflammation were also significantly improved in the AprèsFlex group compared to placebo.


1   Dubey V, Kheni D, Sureja V. Efficacy evaluation of standardized Boswellia serrata extract (Aflapin) in osteoarthritis: A systematic review and sub-group meta-analysis study. Explore (NY). Published online February 10, 2024. doi:10.1016/j.explore.2024.02.001  

  Kumar B, et al. A randomized, double-blind, placebo-controlled clinical study to evaluate the efficacy of a boswellia composition SN13108F to improve joint function and cartilage protection in subjects with mild to moderate osteoarthritis of knee. [Manuscript in development.]


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